Access of patients with myocardial infarction to cardiology reference hospitals

Cross-sectional study conducted in two cardiology reference hospitals. A sample of 100 patients, with a diagnosis of myocardial infarction, was interviewed employing a specific instrument. Mean, standard deviation and percentage values were used in the analysis.

Results

Male subjects; black skin; married; low socioeconomic status and mean age of 56.4 years predominated. The onset of symptoms at home, use of inadequate means of transportation, emergency service as the first place sought for assistance; and admission to cardiology reference hospitals up to the third medical assistance prevailed. Of the 67 patients with myocardial infarction with ST segment elevation, 12% received reperfusion therapies. The lack of resources was the main reason for the pilgrimage within the healthcare system.

Conclusion

Use of inappropriate means of transportation, low proportion of myocardial reperfusion, and lack of structure of the healthcare network to deliver care related to the infarct was observed.

Public health nursing; Education, nursing; Myocardial infarction; Health services; Access to health services; Health services needs and demand

Characteristics related to the access of the participants	n(%)
Place of symptom onset (n=99)*
Home	76(76.8)
Thoroughfare	18(18.2)
Work	5(5.1)
Means of transportation (n=99)*
Mobile emergency medical unit / Regular ambulance	11(11.1)
Automobile / Cab / Motorcycle	72(72.7)
Bus/Walking	16(16.2)
Type of health service sought as the first place of assistance
Service with urgency and emergency assistance **	89(89.0)
Service without urgency and emergency assistance***	11(11.0)
Mentioned knowing where to seek for health care
Yes	23(23.0)
No	77(77.0)
Existence of emergency unit in the neighborhood of residence / stay in Salvador (n=73)****
Yes	62(84.9)
No	11(15.1)
Sought the health services from the neighborhood of residence / stay in Salvador (n=50)*****
Yes	39(78.0)
No	11(22.0)
Conduct of health professionals in the first place for care
Expected conducts	82(82.0)
Unexpected conducts	18(18.0)

Type of health service	Número de serviços de saúde procurados
	First	Second	Third	Fourth	Fifth	Sixth	Seventh
	n=100)	n=99	n=39	n=10	n=5	n=2	n=1
Hospital	41	22	9	4	2	1	-
Emergency Unit	39	12	1	1	-	-	-
Mobile Emergency Service	8	1	-	-	-	-	-
Outpatient Service	7	4	-	-	-	-	-
Primary Healthcare Unit	4	-	-	-	-	-	-
Admission to cardiology reference hospitals*	1	60	29	5	3	1	1
Total	100	99	39	10	5	2	1

Conducts of health professionals	Hospital	Emergency Unit	SAMU*	Primary Healthcare Unit	Outpatient Service	Cardiology Reference Hospitals	Total
Conducts of health professionals	n(%)	n(%)	n(%)	n(%)	n(%)	n(%)	n(%)
Medical assistance, admission and subsequent transfer	61(78.2)	51(96.2)	9(100.0)	2(50.0)	2(18.2)	-	125(80.1)
Medical assistance and orientation to look for another service	5(6.4)	-	-	1(25.0)	7(63.6)	-	13(8.3)
Denial of assistance	7(9.0)	1(1.9)	-	1(25.0)	1(9.1)	1(100.0)	11(7.1)
Medical assistance and subsequent discharge	4(5.1)	1(1.9)	-	-	-	-	5(3.2)
Medical assistance and orientation to look for a cardiologist	1(1.3)	-	-	-	1(9.1)	-	2(1.3)
Total	78(100.0)	53(100.0)	9(100.0)	4(100.0)	11(100.0)	1(100.0)	156(100.0)

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

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[1] Corresponding author: Fernanda Carneiro Mussi. Doutor Augusto Viana Filho Avenue, unnumbered, Salvador, BA, Brasil. Zip Code: 40110-060. femussi@uol.com.br